CAN/ULC-S561-13
APPENDIX C (INFORMATIVE) – TEST AND INSPECTION REPORTS
TABLE C1 – ALARM SIGNAL TRANSMITTER ANNUAL TEST AND INSPECTION REPORT
(Reference: Clause 9.6.1 and 11.1.3.)
Date:
Building Name & Address:
MONITORING SYSTEM DESCRIPTION
Sprinkler System – Alarm and Supervisory Devices:
Fire Alarm System – Manufacturer & Model No.:
Other Equipment – Type/Manufacturer & Model No.:
Alarm Signal Transmitter Manufacturer & Model No.:
Equipment Listing Number:
Name and Location of Fire Signal Receiving Centre:
Fire Signal Receiving Centre ULC Identifier:
Fire Signal Receiving Centre Telephone Number:
1 / The Fire Monitoring System is now fully functional without deficiencies. (If “No”, see “Comments below) / Yes No
2 / ULC “Central Station Fire Protective Signalling Service” Certificate Number:
which is issued for the above noted central monitoring station address is is not attached.
3 / Comments:
4 / A copy of this report will be given to: / Yes No
who is the owner or owner’s representative for this building.
CERTIFICATION
This certifies that the information contained in this Inspection Report (which incorporates the attached / pages) is correct
and complete. The system and equipment described here-in was tested/inspected in conformance with CAN/ULC-S561-13 by a qualified technician. The equipment was left in an operational condition except as noted above. A copy of this report must be maintained on the premises for examination by the Fire Marshal, Building Inspector, or other Authority Having Jurisdiction at their request.
Inspected By: / Contact Information:
Service Company / Insert Contact/Address
Information Here
Technician
Certificate Number:

C2 – TRANSMITTING UNIT TEST RECORD

Date: / Audit Inspection
Building Name: / Address:

“ü” = Yes - Tested correctly “X” = No - Did not test correctly (NO answers are detailed in “Comments/Remarks”) “NA” = Not applicable

C2 Transmitting Unit Test / C2 Power Supply Inspection
Location: / Fused in accordance with manufacturer’s specifications?
Power on visual indicator tested. / Adequate to meet the requirements of the system?
Common visual trouble signal tested. / C2 Emergency Power Supply Test & Inspection
Common audible trouble signal operates. / Location:
Main Power supply failure trouble signal operates. / Panel Number:
Alarm signal operation. / Breaker/Disconnect Number:
Input circuit trouble operates. / Battery type and size (in AH):
Main power supply to emergency power supply operates. / Battery Voltages
C2 Transmitting Unit Inspection / AC power on: / DC Volts
Input circuit designations correctly identified in relation to / AC power off: / DC Volts
connected field devices? / AC power off (full alarm): / DC Volts
Plug-in components and modules properly secured and / Battery Currents (Amperage)
terminated? / AC power on: / DC mA
Designations for common control functions & indicators? / AC power off: / DC mA
Plug-in cables securely in place? / AC power off (full alarm): / /
DC A
Fused in accordance with manufacturer’s specifications? / Correctly sized to provide 24 hours stand-by & 30 or 120
Clean and free of dust and dirt? / minutes alarm operation in accordance with BC Fire Code?
Input circuit alarm and supervisory operation including audible / Inspected for physical damage?
and visual indicator? / Terminals clean and tight?
Control unit lock? / Batteries fused? YES NO
Termination points from wiring to field devices secure? / Adequately ventilated?
Power & field wiring properly terminated to panel ground lug? / Installation date:
Panel adequately grounded?
/ Disconnection causes trouble signal?
Dead-front panel(s) in place & as per manufacturer’s spec? / Battery is within the Manufacturer’s rated life date code?
Record date, revision and version of Firmware & Software / Trouble condition at the emergency generator is indicated?
Date: / Rev: / Version:

C3 - Device Testing – Legend, Notes, and Comments

Device / Description / Type / Model No.
FS / Sprinkler flow switch (1)
FPS / Sprinkler flow pressure switch
TS / Sprinkler valve supervisory tamper switch (2)
LA / Low air supervisory device (3)
LT / Low temperature supervisory device (4)
LPS / Power loss supervisory device
AD / Other ancillary device (5)
FA / Fire alarm control panel

Note 1: Time delay setting of water flow devices shall be recorded in the remarks column.

Note 2: Sprinkler supervisory switches cause a supervisory condition to be annunciated but not an alarm.

Note 3: Upper and lower pressure setting of supervisory devices should be recorded in the remarks column.

Note 4: Low temperature setting should be recorded in the remarks column.

Note 5: Identify Ancillary Device in the remarks column.

C4 - Individual Equipment or Device Record

Date: / Audit Inspection
Building Name: / Address:
Column Legend
A
B
C / Correctly installed
Unit requires service, repair, missing
Alarm operation confirmed / D
E
F / Annunciator indication confirmed
Circuit number or address
Supervision and ground fault detection

“T “ Yes - Acceptable “X” No – Unacceptable (Explain NO answers in comments) “Dash” - Not applicable

Location / Device / A / B / C / D / E / F / Remarks
Remarks/Comments

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